09-15-20 Three Large Studies: Heart Valves, Shoulders and Intubation
Drs. Lucas Bracero, Ramanjot Kang, Saamia Alam and Eric Zabirowicz
6:00 PM @ Microsoft Teams
• Makkar RR et al. Five-Year Outcomes of Transcatheter or Surgical Aortic-Valve Replacement. N Engl J Med. 2020 [PubMed]
• Joffe AM et al. Management of Difficult Tracheal Intubation: A Closed Claims Analysis. Anesthesiology. 2019 Oct;131(4):818-829 [PubMed]
• Kang RA et al. Superior Trunk Block Provides Noninferior Analgesia Compared with Interscalene Brachial Plexus Block in Arthroscopic Shoulder Surgery. Anesthesiology. 2019 Dec;131(6):1316-1326 [PubMed]
Dr. Bracero reviewed regional blocks and presented the Kang et al article. Superior trunk block was compared with interscalene brachial plexus block for 80 patients undergoing arthroscopic shoulder surgery. They found no significant differences in pain score 24 hours after surgery. However, the superior trunk block resulted in significantly less hemidiagphragmatic paresis (76.3% vs 97.5%).
Dr. Alam gave a concise presentation about the Makkar et al article. This randomized control trial compared 2032 patients assigned to either transcatheter or surgical aortic-valve replacement in terms of death or stroked within 5 years. Moreover, they compared transfemoral vs transthoracic access. They found no significant differences between the TAVR and surgical approaches. However, incidence of death or disabling stroke was higher after TAVR than after surgery in the transthoracic-access cohort. In the discussion, it was noted that TAVR has changed how we treat cardiac care patients. Now the majority of our cases are TAVR.
The final article of the evening (Joffe et al) was about failed intubation and is an important one for our specialty. It was presented by Dr. Kang. This closed claim analysis compared 102 claims during 2000 to 2012 with 93 claims during 1993 to 1999. Although there was a higher proportion of death in the more recent claims, the more recent patients were sicker and had more emergency procedures. There was also an increase in the number of claims for non-operative settings. We discussed the importance of good judgement, having a secondary plan and asking for help during a difficult tracheal intubation.
Drs. Figueroa, Mathew and Kim
6:00 PM @ Microsoft Teams
• Khanna AK et al. Prediction of Opioid-Induced Respiratory Depression on Inpatient Wards Using Continuous Capnography and Oximetry: An International Prospective, Observational Trial. Anesth Analg. 2020 Oct;131(4):1012-1024. [PubMed]
• Schwenk ES et al. Mepivacaine versus Bupivacaine Spinal Anesthesia for Early Postoperative Ambulation. Anesthesiology. 2020 Oct 1;133(4):801-811. [PubMed]
• Jang Y-E et al. Subcutaneous Nitroglycerin for Radial Arterial Catheterization in Pediatric Patients. Anesthesiology. 2020 Jul;133(1):53-63. [PubMed]
Dr Mathew gave a terrific review of the Schwenk et al report of a randomized controlled trial of patients undergoing primary total hip arthroplasty. The authors found that patients given mepivacaine ambulated sooner (p < 0.001) and were more likely to be discharged the same day (p < 0.014) in comparison to patients given hyperbaric or isobaric bupivacaine. There was some discussion regarding how the n number was obtained.
Dr. Figueroa gave a concise review of the article by Jang et al. It was really interesting to hear about the potential use of nitroglycerin in pediatric patients. The study concluded that subcutaneous nitroglycerin injection before radial artery cannulation improved the first attempt success rate (91.2% vs. 66.1%, p<0.002). There was also a decrease in the complication rates in patients given ntg.
Dr. B Kim gave a thorough review of the Khanna et al observational trial on opioid-induced respiratory depression. The study concluded that the PRODIGY Score could enable prediction of respiratory depression in patients receiving opioids on the general care floor. Dr Bergese noted that the PRODIGY study has found that these events occur primarily either in the late afternoon or late in the evening. This will be published in a forthcoming study.
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